Tan Youwen, Ye Yun, Zhou Xinbei, Chen Li, Wen Danfeng
Department of Infectious Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China; Department of Hepatosis, The Third Hospital of Zhenjiang Affiliated Jiangsu University, Zhenjiang, China.
Department of Hepatosis, The Third Hospital of Zhenjiang Affiliated Jiangsu University, Zhenjiang, China.
PLoS One. 2015 Apr 17;10(4):e0123452. doi: 10.1371/journal.pone.0123452. eCollection 2015.
Although alanine aminotransferase (ALT) levels reflect the degree of liver damage, not all patients with chronic hepatitis B virus (HBV) infection exhibit persistently elevated ALT levels. In the present study, we aimed to comprehensively evaluate the characteristics of histological abnormalities in a large population of Chinese patients with chronic HBV and persistently normal ALT levels.
In total, 2303 consecutive patients who underwent liver biopsy were screened. Of these patients, 273 were categorized as having persistently normal ALT levels (PNALT), whereas 618 were categorized as having persistently or intermittently elevated ALT levels (PIALT). All these patients had at least three ALT values recorded in the year prior to the baseline liver biopsy.
Significant necroinflammation was observed in 9.7% (11/113) patients with PNALT, 23.3% (42/180) patients with PIALT (ALT 1-2× upper limit of normal [ULN]), and 27.8% (42/151) patients with PIALT (ALT > 2× ULN), whereas significant fibrosis was observed in 8.8% (10/113) patients with PNALT, 27.8% (42/151) patients with PIALT (ALT 1-2× ULN), and 21.2% (32/151) patients with PIALT (ALT > 2× ULN). Multiple logistic regression analysis indicated that age parameters were associated with significant histological abnormalities in patients with PNALT. The area under the curve showed that age was associated with significant fibrosis characteristics in patients with hepatitis B extracellular antigen (HBeAg)-negative PNALT.
Significant histological abnormalities are not often observed in Chinese patients with PNALT. Interestingly, age appears to be a predictor of significant fibrosis in patients with HBeAg-negative PNALT.
尽管丙氨酸氨基转移酶（ALT）水平反映了肝损伤程度，但并非所有慢性乙型肝炎病毒（HBV）感染患者的ALT水平都会持续升高。在本研究中，我们旨在全面评估一大群慢性HBV感染且ALT水平持续正常的中国患者的组织学异常特征。
总共筛选了2303例连续接受肝活检的患者。在这些患者中，273例被归类为ALT水平持续正常（PNALT），而618例被归类为ALT水平持续或间歇性升高（PIALT）。所有这些患者在基线肝活检前一年至少记录了三个ALT值。
在PNALT患者中，9.7%（11/113）出现显著坏死性炎症，在PIALT患者（ALT为正常上限[ULN]的1 - 2倍）中，23.3%（42/180）出现显著坏死性炎症，在PIALT患者（ALT > 2×ULN）中，27.8%（42/151）出现显著坏死性炎症；而在PNALT患者中，8.8%（10/113）出现显著纤维化，在PIALT患者（ALT为正常上限[ULN]的1 - 2倍）中，27.8%（42/151）出现显著纤维化，在PIALT患者（ALT > 2×ULN）中，21.2%（32/151）出现显著纤维化。多因素逻辑回归分析表明，年龄参数与PNALT患者的显著组织学异常相关。曲线下面积显示，年龄与乙肝e抗原（HBeAg）阴性的PNALT患者的显著纤维化特征相关。
PNALT的中国患者中不常观察到显著的组织学异常。有趣的是，年龄似乎是HBeAg阴性的PNALT患者显著纤维化的一个预测因素。
